{"id":383,"date":"2022-05-24T15:35:51","date_gmt":"2022-05-24T20:35:51","guid":{"rendered":"https:\/\/www.bemidjistate.edu\/academics\/social-work\/?page_id=383"},"modified":"2023-10-03T16:08:39","modified_gmt":"2023-10-03T21:08:39","slug":"prospective-social-work-internship-agencies","status":"publish","type":"page","link":"https:\/\/www.bemidjistate.edu\/academics\/social-work\/internships-2\/prospective-social-work-internship-agencies\/","title":{"rendered":"Prospective Social Work Internship Agencies"},"content":{"rendered":"<div class=\"gf_browser_unknown gform_wrapper gravity-theme gform-theme--no-framework\" data-form-theme=\"gravity-theme\" data-form-index=\"0\" id=\"gform_wrapper_2\">\n                        <div class=\"gform_heading\">\n                            <h2 class=\"gform_title\">Prospective Field Placement Agency<\/h2>\n                            <p class=\"gform_description\">If your organization is interested in hosting an intern or a 60-hour field placement student from 91̽»¨&rsquo;s Social Work and\/or LADC programs please complete this Prospective Field Agency online form.  This information helps to best prepare students in making an informed decision about a prospective internship with your agency.  Thank you!<\/p>\n\t\t\t\t\t\t\t<p class=\"gform_required_legend\">\"<span class=\"gfield_required gfield_required_asterisk\">*<\/span>\" indicates required fields<\/p>\n                        <\/div><form method=\"post\" enctype=\"multipart\/form-data\" id=\"gform_2\" action=\"\/academics\/social-work\/wp-json\/wp\/v2\/pages\/383\" data-formid=\"2\" novalidate>\n                        <div class=\"gform-body gform_body\"><div id=\"gform_fields_2\" class=\"gform_fields top_label form_sublabel_below description_below validation_below\"><div id=\"field_2_1\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label class=\"gfield_label gform-field-label\" for=\"input_2_1\">Agency Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class=\"ginput_container ginput_container_text\"><input name=\"input_1\" id=\"input_2_1\" type=\"text\" value=\"\" class=\"medium\" aria-required=\"true\" aria-invalid=\"false\"><\/div><\/div><div id=\"field_2_5\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label class=\"gfield_label gform-field-label\" for=\"input_2_5\">Agency Mailing Address (City, State, ZIP Code)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class=\"ginput_container ginput_container_text\"><input name=\"input_5\" id=\"input_2_5\" type=\"text\" value=\"\" class=\"medium\" aria-required=\"true\" aria-invalid=\"false\"><\/div><\/div><div id=\"field_2_6\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label class=\"gfield_label gform-field-label\" for=\"input_2_6\">Contact Person's Name (First and Last)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class=\"ginput_container ginput_container_text\"><input name=\"input_6\" id=\"input_2_6\" type=\"text\" value=\"\" class=\"medium\" aria-required=\"true\" aria-invalid=\"false\"><\/div><\/div><div id=\"field_2_26\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label class=\"gfield_label gform-field-label\" for=\"input_2_26\">Contact Person's Title<\/label><div class=\"ginput_container ginput_container_text\"><input name=\"input_26\" id=\"input_2_26\" type=\"text\" value=\"\" class=\"medium\" aria-invalid=\"false\"><\/div><\/div><div id=\"field_2_7\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label class=\"gfield_label gform-field-label\" for=\"input_2_7\">Contact Person's Email Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class=\"ginput_container ginput_container_text\"><input name=\"input_7\" id=\"input_2_7\" type=\"text\" value=\"\" class=\"medium\" aria-required=\"true\" aria-invalid=\"false\"><\/div><\/div><div id=\"field_2_2\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label class=\"gfield_label gform-field-label\" for=\"input_2_2\">Agency Website<\/label><div class=\"ginput_container ginput_container_text\"><input name=\"input_2\" id=\"input_2_2\" type=\"text\" value=\"\" class=\"medium\" aria-invalid=\"false\"><\/div><\/div><div id=\"field_2_4\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label class=\"gfield_label gform-field-label\" for=\"input_2_4\">Internship Position Description<\/label><div class=\"ginput_container ginput_container_textarea\"><textarea name=\"input_4\" id=\"input_2_4\" class=\"textarea medium\" aria-invalid=\"false\" rows=\"10\" cols=\"50\"><\/textarea><\/div><\/div><fieldset id=\"field_2_3\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><legend class=\"gfield_label gform-field-label gfield_label_before_complex\">Types of Internship(s) Available<\/legend><div class=\"ginput_container ginput_container_checkbox\"><div class=\"gfield_checkbox \" id=\"input_2_3\"><div class=\"gchoice gchoice_2_3_1\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_3.1\" type=\"checkbox\" value=\"Social Work (480 hours)\" id=\"choice_2_3_1\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_3_1\" id=\"label_2_3_1\" class=\"gform-field-label gform-field-label--type-inline\">Social Work (480 hours)<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gchoice gchoice_2_3_2\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_3.2\" type=\"checkbox\" value=\"Licensed Alcohol and Drug Counselor (880 hours)\" id=\"choice_2_3_2\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_3_2\" id=\"label_2_3_2\" class=\"gform-field-label gform-field-label--type-inline\">Licensed Alcohol and Drug Counselor (880 hours)<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gchoice gchoice_2_3_3\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_3.3\" type=\"checkbox\" value=\"Field Experience (60 hours, no licensed social worker required)\" id=\"choice_2_3_3\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_3_3\" id=\"label_2_3_3\" class=\"gform-field-label gform-field-label--type-inline\">Field Experience (60 hours, no licensed social worker required)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_27\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"><legend class=\"gfield_label gform-field-label gfield_label_before_complex\">Practice Areas<\/legend><div class=\"ginput_container ginput_container_checkbox\"><div class=\"gfield_checkbox \" id=\"input_2_27\"><div class=\"gchoice gchoice_2_27_1\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_27.1\" type=\"checkbox\" value=\"Aging\" id=\"choice_2_27_1\" aria-describedby=\"gfield_description_2_27\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_27_1\" id=\"label_2_27_1\" class=\"gform-field-label gform-field-label--type-inline\">Aging<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gchoice gchoice_2_27_2\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_27.2\" type=\"checkbox\" value=\"Behavioral Health (Children)\" id=\"choice_2_27_2\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_27_2\" id=\"label_2_27_2\" class=\"gform-field-label gform-field-label--type-inline\">Behavioral Health (Children)<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gchoice gchoice_2_27_3\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_27.3\" type=\"checkbox\" value=\"Bereavement\/End of Life\" id=\"choice_2_27_3\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_27_3\" id=\"label_2_27_3\" class=\"gform-field-label gform-field-label--type-inline\">Bereavement\/End of Life<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gchoice gchoice_2_27_4\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_27.4\" type=\"checkbox\" value=\"Hospital\/Health Care\" id=\"choice_2_27_4\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_27_4\" id=\"label_2_27_4\" class=\"gform-field-label gform-field-label--type-inline\">Hospital\/Health Care<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gchoice gchoice_2_27_5\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_27.5\" type=\"checkbox\" value=\"Children, Youth, &amp; Families\" id=\"choice_2_27_5\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_27_5\" id=\"label_2_27_5\" class=\"gform-field-label gform-field-label--type-inline\">Children, Youth, &amp; Families<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gchoice gchoice_2_27_6\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_27.6\" type=\"checkbox\" value=\"Clinical Social Work\" id=\"choice_2_27_6\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_27_6\" id=\"label_2_27_6\" class=\"gform-field-label gform-field-label--type-inline\">Clinical Social Work<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gchoice gchoice_2_27_7\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_27.7\" type=\"checkbox\" value=\"Corrections\" id=\"choice_2_27_7\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_27_7\" id=\"label_2_27_7\" class=\"gform-field-label gform-field-label--type-inline\">Corrections<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gchoice gchoice_2_27_8\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_27.8\" type=\"checkbox\" value=\"Diversity &amp; Equity\" id=\"choice_2_27_8\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_27_8\" id=\"label_2_27_8\" class=\"gform-field-label gform-field-label--type-inline\">Diversity &amp; Equity<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gchoice gchoice_2_27_9\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_27.9\" type=\"checkbox\" value=\"HIV\/AIDS\" id=\"choice_2_27_9\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_27_9\" id=\"label_2_27_9\" class=\"gform-field-label gform-field-label--type-inline\">HIV\/AIDS<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gchoice gchoice_2_27_11\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_27.11\" type=\"checkbox\" value=\"Human Trafficking Survivors\" id=\"choice_2_27_11\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_27_11\" id=\"label_2_27_11\" class=\"gform-field-label gform-field-label--type-inline\">Human Trafficking Survivors<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gchoice gchoice_2_27_12\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_27.12\" type=\"checkbox\" value=\"Immigrants\" id=\"choice_2_27_12\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_27_12\" id=\"label_2_27_12\" class=\"gform-field-label gform-field-label--type-inline\">Immigrants<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gchoice gchoice_2_27_13\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_27.13\" type=\"checkbox\" value=\"International\" id=\"choice_2_27_13\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_27_13\" id=\"label_2_27_13\" class=\"gform-field-label gform-field-label--type-inline\">International<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gchoice gchoice_2_27_14\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_27.14\" type=\"checkbox\" value=\"Mental Health\" id=\"choice_2_27_14\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_27_14\" id=\"label_2_27_14\" class=\"gform-field-label gform-field-label--type-inline\">Mental Health<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gchoice gchoice_2_27_15\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_27.15\" type=\"checkbox\" value=\"Peace Studies, Restorative Justice, &amp; or Social Justice\" id=\"choice_2_27_15\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_27_15\" id=\"label_2_27_15\" class=\"gform-field-label gform-field-label--type-inline\">Peace Studies, Restorative Justice, &amp; or Social Justice<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gchoice gchoice_2_27_16\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_27.16\" type=\"checkbox\" value=\"School Social Work\" id=\"choice_2_27_16\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_27_16\" id=\"label_2_27_16\" class=\"gform-field-label gform-field-label--type-inline\">School Social Work<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gchoice gchoice_2_27_17\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_27.17\" type=\"checkbox\" value=\"Treatment, Alcohol &amp; Other Drugs\" id=\"choice_2_27_17\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_27_17\" id=\"label_2_27_17\" class=\"gform-field-label gform-field-label--type-inline\">Treatment, Alcohol &amp; Other Drugs<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gchoice gchoice_2_27_18\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_27.18\" type=\"checkbox\" value=\"Violence, Community\" id=\"choice_2_27_18\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_27_18\" id=\"label_2_27_18\" class=\"gform-field-label gform-field-label--type-inline\">Violence, Community<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gchoice gchoice_2_27_19\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_27.19\" type=\"checkbox\" value=\"Violence, Intimate Partner\" id=\"choice_2_27_19\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_27_19\" id=\"label_2_27_19\" class=\"gform-field-label gform-field-label--type-inline\">Violence, Intimate Partner<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class=\"gfield_description\" id=\"gfield_description_2_27\">(Select all that apply.)<\/div><\/fieldset><div id=\"field_2_11\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label class=\"gfield_label gform-field-label\" for=\"input_2_11\">Other Area(s) of Practice:<\/label><div class=\"ginput_container ginput_container_text\"><input name=\"input_11\" id=\"input_2_11\" type=\"text\" value=\"\" class=\"medium\" aria-invalid=\"false\"><\/div><\/div><div id=\"field_2_12\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label class=\"gfield_label gform-field-label\" for=\"input_2_12\">Agency's Primary Programs<\/label><div class=\"ginput_container ginput_container_textarea\"><textarea name=\"input_12\" id=\"input_2_12\" class=\"textarea medium\" aria-invalid=\"false\" rows=\"10\" cols=\"50\"><\/textarea><\/div><\/div><fieldset id=\"field_2_13\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><legend class=\"gfield_label gform-field-label\">Does the Agency require or prefer the prospective intern to have any particular educational and\/or experiential background?<\/legend><div class=\"ginput_container ginput_container_radio\"><div class=\"gfield_radio\" id=\"input_2_13\">\n\t\t\t<div class=\"gchoice gchoice_2_13_0\">\n\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_13\" type=\"radio\" value=\"Yes\" id=\"choice_2_13_0\" onchange=\"gformToggleRadioOther( this )\">\n\t\t\t\t\t<label for=\"choice_2_13_0\" id=\"label_2_13_0\" class=\"gform-field-label gform-field-label--type-inline\">Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class=\"gchoice gchoice_2_13_1\">\n\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_13\" type=\"radio\" value=\"No\" checked id=\"choice_2_13_1\" onchange=\"gformToggleRadioOther( this )\">\n\t\t\t\t\t<label for=\"choice_2_13_1\" id=\"label_2_13_1\" class=\"gform-field-label gform-field-label--type-inline\">No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_15\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label class=\"gfield_label gform-field-label\" for=\"input_2_15\">If yes, please explain<\/label><div class=\"ginput_container ginput_container_text\"><input name=\"input_15\" id=\"input_2_15\" type=\"text\" value=\"\" class=\"medium\" aria-invalid=\"false\"><\/div><\/div><div id=\"field_2_16\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label class=\"gfield_label gform-field-label\" for=\"input_2_16\">Please indicate the number of interns the agency is willing to accept.<\/label><div class=\"ginput_container ginput_container_number\"><input name=\"input_16\" id=\"input_2_16\" type=\"number\" step=\"any\" min=\"1\" max=\"5\" value=\"\" class=\"medium\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_2_16\"><div class=\"gfield_description instruction \" id=\"gfield_instruction_2_16\">Please enter a number from <strong>1<\/strong> to <strong>5<\/strong>.<\/div><\/div><\/div><fieldset id=\"field_2_35\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><legend class=\"gfield_label gform-field-label gfield_label_before_complex\">During which semester(s) is the agency willing to host interns?<\/legend><div class=\"ginput_container ginput_container_checkbox\"><div class=\"gfield_checkbox \" id=\"input_2_35\"><div class=\"gchoice gchoice_2_35_1\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_35.1\" type=\"checkbox\" value=\"Fall (August - December)\" id=\"choice_2_35_1\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_35_1\" id=\"label_2_35_1\" class=\"gform-field-label gform-field-label--type-inline\">Fall (August &ndash; December)<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gchoice gchoice_2_35_2\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_35.2\" type=\"checkbox\" value=\"Spring (January - May)\" id=\"choice_2_35_2\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_35_2\" id=\"label_2_35_2\" class=\"gform-field-label gform-field-label--type-inline\">Spring (January &ndash; May)<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gchoice gchoice_2_35_3\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_35.3\" type=\"checkbox\" value=\"Summer (May - July)\" id=\"choice_2_35_3\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_35_3\" id=\"label_2_35_3\" class=\"gform-field-label gform-field-label--type-inline\">Summer (May &ndash; July)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_36\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><legend class=\"gfield_label gform-field-label gfield_label_before_complex\">Has your agency hosted interns in the past?<\/legend><div class=\"ginput_container ginput_container_checkbox\"><div class=\"gfield_checkbox \" id=\"input_2_36\"><div class=\"gchoice gchoice_2_36_1\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_36.1\" type=\"checkbox\" value=\"Yes, from BSU\" id=\"choice_2_36_1\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_36_1\" id=\"label_2_36_1\" class=\"gform-field-label gform-field-label--type-inline\">Yes, from BSU<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gchoice gchoice_2_36_2\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_36.2\" type=\"checkbox\" value=\"Yes, from other universities\" id=\"choice_2_36_2\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_36_2\" id=\"label_2_36_2\" class=\"gform-field-label gform-field-label--type-inline\">Yes, from other universities<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gchoice gchoice_2_36_3\">\n\t\t\t\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_36.3\" type=\"checkbox\" value=\"No\" id=\"choice_2_36_3\">\n\t\t\t\t\t\t\t\t<label for=\"choice_2_36_3\" id=\"label_2_36_3\" class=\"gform-field-label gform-field-label--type-inline\">No<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_19\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><legend class=\"gfield_label gform-field-label\">Will the intern need a personal car to perform responsibilities?<\/legend><div class=\"ginput_container ginput_container_radio\"><div class=\"gfield_radio\" id=\"input_2_19\">\n\t\t\t<div class=\"gchoice gchoice_2_19_0\">\n\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_19\" type=\"radio\" value=\"Yes\" id=\"choice_2_19_0\" onchange=\"gformToggleRadioOther( this )\">\n\t\t\t\t\t<label for=\"choice_2_19_0\" id=\"label_2_19_0\" class=\"gform-field-label gform-field-label--type-inline\">Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class=\"gchoice gchoice_2_19_1\">\n\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_19\" type=\"radio\" value=\"No\" id=\"choice_2_19_1\" onchange=\"gformToggleRadioOther( this )\">\n\t\t\t\t\t<label for=\"choice_2_19_1\" id=\"label_2_19_1\" class=\"gform-field-label gform-field-label--type-inline\">No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class=\"gchoice gchoice_2_19_2\">\n\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_19\" type=\"radio\" value=\"gf_other_choice\" id=\"choice_2_19_2\" onchange=\"gformToggleRadioOther( this )\">\n\t\t\t\t\t<label for=\"choice_2_19_2\" id=\"label_2_19_2\" class=\"gform-field-label gform-field-label--type-inline\">Other<\/label><br><input id=\"input_2_19_other\" class=\"gchoice_other_control\" name=\"input_19_other\" type=\"text\" value=\"Other\" aria-label=\"Other Choice, please specify\" disabled>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_20\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><legend class=\"gfield_label gform-field-label\">Does the Agency reimburse mileage to interns for use of their own car?<\/legend><div class=\"ginput_container ginput_container_radio\"><div class=\"gfield_radio\" id=\"input_2_20\">\n\t\t\t<div class=\"gchoice gchoice_2_20_0\">\n\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_20\" type=\"radio\" value=\"Yes\" id=\"choice_2_20_0\" onchange=\"gformToggleRadioOther( this )\">\n\t\t\t\t\t<label for=\"choice_2_20_0\" id=\"label_2_20_0\" class=\"gform-field-label gform-field-label--type-inline\">Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class=\"gchoice gchoice_2_20_1\">\n\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_20\" type=\"radio\" value=\"No\" checked id=\"choice_2_20_1\" onchange=\"gformToggleRadioOther( this )\">\n\t\t\t\t\t<label for=\"choice_2_20_1\" id=\"label_2_20_1\" class=\"gform-field-label gform-field-label--type-inline\">No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_21\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><legend class=\"gfield_label gform-field-label\">Does the Agency reimburse interns for expenses rather than mileage?<\/legend><div class=\"ginput_container ginput_container_radio\"><div class=\"gfield_radio\" id=\"input_2_21\">\n\t\t\t<div class=\"gchoice gchoice_2_21_0\">\n\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_21\" type=\"radio\" value=\"Yes\" id=\"choice_2_21_0\" onchange=\"gformToggleRadioOther( this )\">\n\t\t\t\t\t<label for=\"choice_2_21_0\" id=\"label_2_21_0\" class=\"gform-field-label gform-field-label--type-inline\">Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class=\"gchoice gchoice_2_21_1\">\n\t\t\t\t\t<input class=\"gfield-choice-input\" name=\"input_21\" type=\"radio\" value=\"No\" checked id=\"choice_2_21_1\" onchange=\"gformToggleRadioOther( this )\">\n\t\t\t\t\t<label for=\"choice_2_21_1\" id=\"label_2_21_1\" class=\"gform-field-label gform-field-label--type-inline\">No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_22\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"><label class=\"gfield_label gform-field-label\" for=\"input_2_22\">Name &amp; credentials of agency-designated field instructor (1)<\/label><div class=\"ginput_container ginput_container_text\"><input name=\"input_22\" id=\"input_2_22\" type=\"text\" value=\"\" class=\"medium\" aria-describedby=\"gfield_description_2_22\" aria-invalid=\"false\"><\/div><div class=\"gfield_description\" id=\"gfield_description_2_22\">The field instructor will provide weekly supervision for one hour and work closely with the intern.<\/div><\/div><div id=\"field_2_23\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label class=\"gfield_label gform-field-label\" for=\"input_2_23\">Educational degree(s) of agency-designated field instructor (1)<\/label><div class=\"ginput_container ginput_container_text\"><input name=\"input_23\" id=\"input_2_23\" type=\"text\" value=\"\" class=\"medium\" aria-invalid=\"false\"><\/div><\/div><div id=\"field_2_31\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label class=\"gfield_label gform-field-label\" for=\"input_2_31\">Email of field instructor (1)<\/label><div class=\"ginput_container ginput_container_text\"><input name=\"input_31\" id=\"input_2_31\" type=\"text\" value=\"\" class=\"medium\" aria-invalid=\"false\"><\/div><\/div><div id=\"field_2_30\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label class=\"gfield_label gform-field-label\" for=\"input_2_30\">Phone number of field instructor (1)<\/label><div class=\"ginput_container ginput_container_text\"><input name=\"input_30\" id=\"input_2_30\" type=\"text\" value=\"\" class=\"medium\" aria-invalid=\"false\"><\/div><\/div><div id=\"field_2_24\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"><label class=\"gfield_label gform-field-label\" for=\"input_2_24\">Name &amp; credentials of agency-designated field instructor (2)<\/label><div class=\"ginput_container ginput_container_text\"><input name=\"input_24\" id=\"input_2_24\" type=\"text\" value=\"\" class=\"medium\" aria-describedby=\"gfield_description_2_24\" aria-invalid=\"false\"><\/div><div class=\"gfield_description\" id=\"gfield_description_2_24\">The field instructor will provide weekly supervision for one hour and work closely with the intern.<\/div><\/div><div id=\"field_2_25\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label class=\"gfield_label gform-field-label\" for=\"input_2_25\">Educational degree(s) of agency-designated field instructor (2)<\/label><div class=\"ginput_container ginput_container_text\"><input name=\"input_25\" id=\"input_2_25\" type=\"text\" value=\"\" class=\"medium\" aria-invalid=\"false\"><\/div><\/div><div id=\"field_2_32\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label class=\"gfield_label gform-field-label\" for=\"input_2_32\">Email of field instructor (2)<\/label><div class=\"ginput_container ginput_container_text\"><input name=\"input_32\" id=\"input_2_32\" type=\"text\" value=\"\" class=\"medium\" aria-invalid=\"false\"><\/div><\/div><div id=\"field_2_33\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below 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